B-po05-216 snaring the snare: an unusual case of a broken snare during lead extraction

Lead extraction can be associated with significant technical challenges, including lead fracture, which may require snaring. To describe a rare complication of lead snaring where a piece of the snare broke and required a second snare for successful retrieval. N/A A 60-year-old male with pacing-mediated cardiomyopathy and lead malfunction presented for lead extraction and upgrade to a biventricular ICD. During extraction of the right ventricular (RV) lead, snaring was required. Due to aggressive pulling with a gooseneck snare, the snare's distal loop fractured, with subsequent dislodgment into the RV inferior base under the tricuspid valve (A, B). With the assistance of interventional radiology (IR), an attempt to retrieve the fragment using an EnSnare multilobed snare (Merit Medical, South Jordan, UT) through a long access sheath via right internal jugular (RIJ) vein approach was unsuccessful (C). Subsequently, the long sheath was exchanged for a deflectable Agilis sheath which was advanced to the RV. The Agilis sheath was then deflected under the valve (D), allowing the EnSnare to be advanced to a better position below the valve, facilitating successful capture and removal of the embolized fragment (F). The planned upgrade procedure was then completed without any further complications. Snare devices can fracture during lead extraction and embolize to the cardiac chambers. Collaboration with IR for such situations is critical. The use of multilobed snares through a deflectable sheath from a superior approach can facilitate removal of fragments from inferior, sub-tricuspid valve locations.